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Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn't have to.

This is indeed a huge draw back to Obamacare and he doesn't really respond to this issue. Another issue he didn't even bother to mention at all is that Obamacare does (almost) nothing to reduce the cost of healthcare. Somehow the USA spends more than any other country by far, as a percent of GDP, on its healthcare. And this bill doesn't make healthcare more affordable for middle class families in any way. If you read through that list I can't find a single thing that will actually reduce the cost of healthcare overall. So if it isn't reducing the cost then how exactly is it more affordable?

The program works decently for the very poor. The program leaves the middle class in the same crappy situation they were before where they spend way too much of their income on medical care. The program takes another small chunk out of rich people's income. Basically he bought poor people's votes and lost rich people's, but politically that works great. The middle class doesn't seem to care too much either way, except for the limiting freedoms part.

Also, the program forces men to pay the cost of women's health insurance, despite the fact that women spend far more than men do on health care. People without children being forced to pay even more than now for the healthcare of other people's kids via the "stay under your parent's plan for X more years" part.

Instead of focusing on this arguments in his ridiculous FAQ section he should have discussed these types of real concerns which are plainly unfair to some people, and limit the freedom of all people.

I appreciate the response. I'd like to take a few of your comments and discuss.

Another issue he didn't even bother to mention at all is that Obamacare does (almost) nothing to reduce the cost of healthcare

This is a real problem in the United States. There are several causes of this, and the government cannot control all of it. But the law does in fact make several large changes that are intended to reduce the national cost on healthcare. The first big change will be a shift in payment models. One of the biggest drivers of health cost in the US is repeated visits to the hospital/doctor/clinic/whatever. In the future costs will be determined by the quality of care received, not the number of services provided. If a doctor missed something and you have to be readmitted, well then there will be a reduction in payment, incentivizing higher quality service.

Also, another cost reducing measure the law takes is the requirement of preventative care to be included in insurance plans.

And this bill doesn't make healthcare more affordable for middle class families in any way.

You are generally right here, but I'll detail the reasons why this is the case. The PPACA, for the most part, was a bill dealing with insurance company payments. The current healthcare industry works on small profit margins (3-3.5% on average), and the bill doesn't want to cut into that already thin profit margin. How then should we reduce the cost of private insurance payments from any class in the US without cutting into an already thin margin? The only way that I see it happening is by reducing the cost of healthcare itself, which was not a primary goal of the legislation. So this point essentially becomes the same as your first comment: Costs aren't lowered that much by the bill.

Basically he bought poor people's votes and lost rich people's, but politically that works great.

I think that's a pretty bad way of looking at the picture. You may think that presidents go around saying "hey, lets do a bill this way so that poor people like me better", but that's not actually what happens. The PPACA did have a goal of bringing healthcare to everyone, but I dont' think that's "buying votes", it's "improving america for everyone". Also, any rich person who throws a fit over a 0.9% tax rate is only upset because they don't remember what real tax increases are. A 0.9% increase is a pittance, not a war on the wealthy.

Also, the program forces men to pay the cost of women's health insurance, despite the fact that women spend far more than men do on health care.

Well, yes, kind of, sorta, maybe? My understanding is that women spend more on healthcare largely based on the cost of pregnancy, the addition of annual gynecologist visits, and the fact that they live longer. Typically pregnancy is a shared choice between two people, but somehow women bear the lifetime cost? That's not fair. I could go a bit more into this, but here's the crux of the issue: Being female is a pre-existing condition. The PPACA has a goal of eliminating pricing as a result of pre-existing conditions. Therefore, being female is no longer a legal or valid reason to charge higher costs.

real concerns which are plainly unfair to some people, and limit the freedom of all people.

I simply disagree that things are "plainly unfair". I agree that some people come out better than other, but this is a massive re-organization and things change from time to time. Nothing here are major injustices. Also, and this is just a small pet peeve, but don't throw around the word freedom like that. One could say that they see the mandate as a limit on liberty, but I could just as easily say that my personal liberty has been increased, giving me higher and more equal footing to engage in the health insurance industry. A very righteous sounding way of expressing this would be "No longer am I oppressed by the tyranny of the health insurance industry, for previously if I went without I would have no life, and if I went with I would have no money, or footing on which to dispute claim rejection."

But, I think you have thought things through and I totally understand that, especially on this last point, there is no objective answer. Some people like it, some people don't. It's the system we have now, and instead of spending time and money trying to get rid of it, I'd much rather have everyone trying to improve it as necessary.

The only way that I see it happening is by reducing the cost of healthcare itself, which was not a primary goal of the legislation.

I agree that the bill didn't do that. But the explanation you linked to says,

Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone.

Which is why I think it is a poor explanation and definitely very one sided.

My understanding is that women spend more on healthcare largely based on the cost of pregnancy, the addition of annual gynecologist visits, and the fact that they live longer.

The fact that women live longer shouldn't be (and most likely isn't) a factor in determining the increased cost of health insurance. After someone reaches a certain age they no longer have to purchase health insurance, after all. So that really is a moot point.

The idea that a third party - someone not even involved with the woman in any way - should pay for the birth of someone else's child seems unfair to me as well. Right now that isn't the case and I don't see what the problem is. The woman's partner can pay for it in many cases. People are already subsidizing other people's offspring in a lot of ways - tax credits and paying for school are a couple of example. Do we really need more of that? I think that people should bear some of their own costs in having a child but the direction we're heading they won't have to at all eventually. Also, even without that change, poor women who were truly in need could use the change to medicare or the heavily subsidized health insurance to receive help.

Do you feel that males shouldn't be discriminated against for car insurance, either? If not it seems like a double standard to me. Personally I think men should pay more for car insurance and women should pay more for medical insurance. I don't see what the problem is.

I agree that some people come out better than other, but this is a massive re-organization and things change from time to time

That is a fantastically political way of putting it, lol. To hard working middle class men who don't want to have children, "We're going through some minor reorganization!" Meanwhile they're likely out another ten thousand dollars or more over the course of their life. This group of people is already paying in a disproportionate share of taxes and is also receiving almost no benefit in exchange. For example, social security another program that men pay more into but receive less out of. If we continue setting up these systems we are really making things unfair.

Some people like it, some people don't.

The people that have the money transferred to them like it. The people that had money transferred away from them don't. Obviously it isn't that black and white and I am sure there are parts of each group that like/dislike it. But definitely overall...

Finally please don't tell me how to use the word freedom. The way I used it is completely valid, even if you personally disagree with it. This is how I see freedom and it makes a heck of a lot more sense to me than the type of freedom you're talking about. A bird in the wild is completely free, even if things aren't given to them on a silver platter. An animal in the zoo is not, even if they are given top notch medical care and given better food than they would receive in the wild.

Also, the program forces men to pay the cost of women's health insurance, despite the fact that women spend far more than men do on health care.

That seems fair to me. Society can't exist without both men and women, so it makes sense to make their healthcare costs about equal. This is different from personal choices, such as smoking, which people should have to pay more for on their own.

The middle class doesn't seem to care too much either way, except for the limiting freedoms part.

What freedoms exactly are being limited? Keep in mind that "the freedom to not have health insurance" is not a real freedom, since doctors will not just let you die - the taxpayer will be forced to pay for emergency care. Those who willfully do not purchase health insurance are not exercising a freedom, they're intentionally placing a burden on the rest of society.

Anyway, I agree that the ACA did not address the real issue of healthcare in America, which is, as you said, prices for the middle-class... but how can that be fixed when the ACA itself barely passed? You think there's any chance that an even stronger bill would have made it through both houses? One that included a single payer system, fixed-published costs for procedures, and collective negotiating for drug prices?

The freedom for a person who works hard and earns his/her own money to spend it how they please.

but how can that be fixed when the ACA itself barely passed? You think there's any chance that an even stronger bill would have made it through both houses?

We didn't need a "stronger" bill. We needed to either cap the cost or health care or allow more competition. And to not mandate massive healthcare at the very end of a person's life which is driving the cost up for everyone. That wasn't ever what the discussion was about from any candidate.

The freedom for a person who works hard and earns his/her own money to spend it how they please.

A "freedom" already infringed upon by sales tax, income tax, controlled substance restrictions, import restrictions, and a myriad of other laws. People are not free to spend their money on literally anything or in any way they wish, nor should they be. That argument is a complete non-starter.

You're right that I never had it. But it was definitely the idea that the country was founded upon. Federal spending has been increasing year by year from a starting point of almost nothing. And this graph actually down plays the spending considering it is shown as a % of GDP and GDP used to be much smaller in older times:

How do you figure? To be fair, the Boston Tea Party was because the crown was trying to get them to stop buying black market tea, but the taxes put in place made the legit tea cheaper so the revolt was just people being jerks over being told what to do. Taxes in certain forms were put into the constitution (Mostly limited to alcohol, tariffs and stuff that crosses borders as I recall but not going to look it up) so taxes to fund the government and it's programs were there from the start. The whole "taxation without representation" thing was all about having a more of a say in how they were being taxed, not that they were being taxed at all.

At what point were the founding fathers looking to form this tax free utopia you describe?

I am not talking about a tax free utopia. A reasonable level of government spending is nothing I would be complaining about. But the amount of spending going on, especially at the federal level, is astonishing to me. When you boil it down, the current level of spending basically means our tax rate is 38%. That means 38% of what we make people have no direct control over. But it is even worse than that because of programs like Obamacare that don't even first into that figure. If we continue to grow this then soon people will have every little control over their own lives.

I'm interested in how you would cap the cost of health care. The only way I can see of doing that would be to allow a public option (which also increases competition).

Obamacare doesn't mandate massive healthcare at the end of someone's life. While it is true that one of the parties in America is very opposed to the "right to die", it isn't the one that pushed Obamacare through.

I just want to preface it by saying I am not in favor of the changes I am about to propose. I always thought the biggest problem in USA health care is that it is overly controlled which adds a high bureaucratic cost and that we have limited freedom way too much. The changes I would have liked to see the the US health care system are changes like this and perhaps free care for disabled or mentally handicapped people.

But I think capping the cost of certain procedures, at the expense of doctors and hospitals, is the clearest thing. Currently doctors are afforded higher wages because of the protection governments grant their trade. A hospital acts as a monopoly for most medical procedures/practices in most areas and supply is artificially a lot lower than it should be. Because of that it is not that unreasonable to cap the amount health care professionals can charge for a given operation. I think that leads to its own set of problems but at least off sets (too much in some cases, too little in others) the advantage government has given these people.

I personally liked a public option where US citizens simply get health care without immediate charge, no questions asked a lot more than something like this. Then you get rid of many overhead costs associated with medical care. There would be no more need for insurance company middle men - covering both their profits and their expenses. There would be no need for IRS forms or IRS agents or courts to go after people that didn't pony up their money. These are real costs and they are big. And so on.

That said I wouldn't like this solution much either since it is also inherently unfair and still doesn't address the real problem of spiral prices.

Yeah the massive costs aren't a result of Obamacare and I don't think I said that anywhere. If I did I didn't mean to. Obamacare claimed to try to reduce costs and I think it will do so minimally at best. There were definitely much better ways to address that problem than the very weak one of getting people to "seek preventative care". I honestly think that is a joke and can't believe people are buying it so much. Does the USA right now focus a lot less than other counties on preventative care? I doubt it and if that is true I'd be interested in seeing a good, unbiased source on that subject (not trying to berate you here since you didn't even bring that up).

I also think that a single payer system is the best reasonable option.

Frankly, I'd like it if all politicians were restricted to the health care options that ordinary citizens could afford.

I think the spiraling costs of health care are likely to be tied to private insurance and private hospitals. I'm honestly not educated enough about them to really nail that thought down. I just figure that if we're an outlier both in costs and privatization they two are likely related.

I'm a little bit fearful of government mandated costs for procedures. One thing the government constantly screws up is understanding science and technology. Having a beauracrat decide how much can be charged for an MRI vs an iMRI (or whatever the appropriate example is) would likely just guide hospitals into buying the equipment that provided the best return on investment. Thus the more expensive equipment that did a better testing or procedures would never even be researched (let alone purchased). The emphasis would be on cafeteria style medicine. Leaner, cheaper, and able to match the technical requirements of some bill that was passed by a corrupt drunken lawyer years prior.

I view Obamacare as not trying to "get" people to seek preventative medicine so much as "enabling" them to do so. It might be a nuanced difference, but it's important to me.

I think the spiraling costs of health care are likely to be tied to private insurance and private hospitals. I'm honestly not educated enough about them to really nail that thought down. I just figure that if we're an outlier both in costs and privatization they two are likely related.

The problem is that we haven't got free markets in the USA. The AMA has completely eliminated the ability for people to control how they deal with their health care. It has also artificially lowered supply and added a large overhead cost. Finally, medicare spends a truly ridiculous amount of money on people in the last year/months of their life. To me the high costs are largely because of government intervention. If we actually had freedom we would likely see costs go down.

I guess I believe that some things do need to be regulated. I'm not going to defend the AMA, but I do defend the idea that someone should decide what is and isn't allowed as medicine.

Interestingly enough, if we could just let more people practice less regulated medicine, I bet those end of life expenses medicare has been dealing with would drop dramatically - even if costs stayed the same.

Part of the problem with catastrophic insurance plans is that they're often junk insurance; they tend to have high deductibles (like you mentioned) and also yearly and/or lifetime caps. I call these plans junk insurance because they're not actually insuring you. If you get really sick and hit your cap, you go bankrupt paying your medical bills.

Many are changing that include maximum payout caps (which is kind of ironic given the purpose of catastrophic insurance is to pay for really expensive treatments). Insurance plans can no longer have maximum coverage caps.

Eventually everyone will be dead, but it makes no sense to make the living pay for extravagant funerals for everyone. If everyone will eventually be old, then they can pay for it when they're old. There's no reason to steal from the youth in order to distort price signals for the elderly.

There's no reason to steal from the youth in order to distort price signals for the elderly.

Yes! In a truly free insurance market, if you want to save on insurance costs, you should simply die earlier (avoid being old), or not be a woman who is at risk of bearing children (insurance companies can provide discounts to women who undergo historectimies).

There is a good reason modern societies decide not to discriminate on age or sex in determining health insurance costs. It is moral and not barbaric.

Maybe having the concept of risk-weighted insurance at all for healthcare is absurd. If the gov didn't provide Medicare, anyone over 65 would be SOL for healthcare. As it stands now, the o,see you are, your only hope of affordable health insurance is to be in a risk pool with a bunch of young people to subsidize you (via company provided health insurance). Sucks to be over 40.

You knows society needs females, I'd like to think it also needs old people. Creating an environment where those two groups are significantly penalized would quickly lead to gov overthrow. Libertarians beware.

It's about the personal decision of whether someone wants to buy term or whole life. You seem to be very conceited and arrogant in wanting to force people to make a certain decision. Should we force people to eat right and exercise too? Think of how much healthier people will be and how much money we'd save as tax payers...

I have no problem with charging people with unhealthy habits more for their health insurance if you want to go there. Yes, that means...they are economically pressured, if not forced, to choose healthier lifestyles. Age and sex is not something we can control, but lifestyle definitely is.

But even then, we have to be careful: how would you classify someone as having an unhealthy life style? At the end of the day, we will probably eventually wind up with something like the Swiss system of mandatory health insurance where opportunities to discriminate are very little and fairness is enforced by not allowing employers to provide it as a benefit (insurance is still private, but companies have little room to offer variation, subsidies are provided to the poor of course).

But if you are so against this, what is your better plan? The previous system of have and have not's + a civilized moral imperative to still treat people without insurance is unsustainable. Republicans harp on how bad ObamaCare will be, but most of us are not interested going back to the old system. And they have provided no alternative vision on how to reform healthcare. Libertarians are much worse: they would just have all poor and old people die in the street; they offer nothing but regressions to feudalism.

This is the underlying issue for many people that is rarely talked about, and I'm glad you mentioned it. I'll try my best to address it now.

Although it is undeniable that the outcomes under Obamacare aren't 100% "fair" to all people (for the reasons you mentioned, such as men ponying up more to pay for women), outcomes under the current system are hardly fair either. Sure, women spend more than men on healthcare, but is that all their fault? Inherently, because women are at more risk for more health issues, they will end up spending more, just by virtue of how they were born. Would it be fair to, say, impose a tax on all baby boys when they're born just because most people in the prison system (using your tax dollars) are male?

It's the same issue for any illness, really. I'm a healthy person, that by virtue of circumstances doesn't have any hereditary issues to deal with, and haven't been to a doctor for years. Surely I'm not at fault for someone else's cancer, so why should I pay for it? Because that person with cancer or a broken bone or arthritis is just as innocent as me, and did nothing to deserve their condition. Sure, you can point to smokers and the morbidly obese and argue that they knowingly increased their likelihood of disease and are therefore responsible (I would agree with you on that), but the reality is that healthcare costs brought on by these people are grossly outweighed by the healthcare costs of "innocents".

As for Obamacare limiting the freedom of all people, I don't see how this is an issue. Obamacare doesn't FORCE you to have any particular insurance, unless it's by virtue of pricing you out of higher end healthcare plans. In that case, I would again argue that the current system also "limits freedoms". Many people are currently priced out of having any healthcare plan at all. Many people are forced into debt for years and decades just because they happened to get sick and there was nothing they could do about it. Working to get out of debt is hardly "free" - it's akin to indentured servitude.

Would it be fair to, say, impose a tax on all baby boys when they're born just because most people in the prison system (using your tax dollars) are male?

Not exactly a good analogy.

There is no alternative here to look at. Men can't have babies.

There are numerous alternatives for prison, or reasons why men are a larger percentage of the prison population.

Equating the two isn't really valid. One is by birth, the other is by choice(albeit generally a societal choice on top on an individual one). If men had some sort of birth issue that caused this, then it'd be more valid. However, I have yet to see anything definitively linking male biology to prison rates(which still wouldn't be entirely valid because criteria for going to prison is so wildly varied).

You're essentially comparing something that's relatively well understood(why women pay more), with something that's relatively not as well understood(spending over a decade in LE/Corrections, I can tell you there's tons of debate over our system).

As for Obamacare limiting the freedom of all people, I don't see how this is an issue. Obamacare doesn't FORCE you to have any particular insurance, unless it's by virtue of pricing you out of higher end healthcare plans.

It still forces you to buy something from a private party. This is my main issue with it. I'd prefer single payer over this. There is no reason the Government should force you to buy something from a private entity for merely existing. Period.

In that case, I would again argue that the current system also "limits freedoms". Many people are currently priced out of having any healthcare plan at all. Many people are forced into debt for years and decades just because they happened to get sick and there was nothing they could do about it. Working to get out of debt is hardly "free" - it's akin to indentured servitude.

In a way it does, but it is a different way. It's a reactive limit to freedom. The mandate is not.

Whether or not you get sick, your freedom gets limited.

My biggest concern with this actually is the precedent it sets. What's next that we can be forced to buy? All they need to do for public opinion apparently is convince you(not you specifically, but people in general) it's "good for society", and people seem fine with being told they must buy something.

We have all been forced to buy car insurance if we want to participate in the automobile market, and now we have to buy medical insurance to participate in the medical market. This is not new, nor is it precendent setting.

Also, and this is just a question, but why the opposition to the public option? I see little reason why the government can't participate in the open free market. If private industry truly is more efficient than government, than they will be able to provide better rates for better service. If the Public Option gives the best cost/benefit ratio why shouldn't we take it. I have trouble understanding why people who support competitive marketplaces rail against the government being allowed to participate. Isn't the idea that whoever has the best model wins, or forces everybody else to up their game? Shouldn't this be encouraged?

To be clear, I'm both asking a serious question because I don't understand the opposition, and bringing into question the parts of the argument that I do understand.

We have all been forced to buy car insurance if we want to participate in the automobile market, and now we have to buy medical insurance to participate in the medical market. This is not new, nor is it precendent setting.

You must be car insurance only to drive on public roads. You can drive on your own property all day long without ever buying insurance/tabs/etc.

To live in America after a certain age, you now must buy medical insurance. This is most definitely precedent setting.

Also, and this is just a question, but why the opposition to the public option? I see little reason why the government can't participate in the open free market.

I actually don't have an opposition to this. Frankly, I'd prefer single payer over this.

Just thought I'd chime in regarding the free market bit. I think part of the issue is that the government can "rig the game" so that its own services can be better than those offered by private companies. For instance, the government could use taxpayer money to subsidize lower rates, allowing them to unfairly compete.

I don't think the public option would do that for certain, but that's the kind of objection I've heard the most.

As for Obamacare limiting the freedom of all people, I don't see how this is an issue. Obamacare doesn't FORCE you to have any particular insurance, unless it's by virtue of pricing you out of higher end healthcare plans. In that case, I would again argue that the current system also "limits freedoms". Many people are currently priced out of having any healthcare plan at all. Many people are forced into debt for years and decades just because they happened to get sick and there was nothing they could do about it. Working to get out of debt is hardly "free" - it's akin to indentured servitude.

This guy gets it. If the government demands citizens to spend money it's an infringement of liberties. If the markets force you to, its capitalism.

The difference is in a true capatilist system, there would be incentive to provide affordable services to the class left out by the high priced plans. When the government is essentially guaranteeing 20% profit to existing health care corporations and mandating that every american be a customer, it leaves no incentive for any real competition thus inflating the cost of health care for everybody.

I'm not against the idea of state marketplaces under the current system. I'm just saying that it's not capitalism and I believe that in a true capitalist system health care would be cheaper than it is now or will be under the PPACA. Health care should not be attached to emploer benefits, or limited to intrastate options. The laws are hurting many in ways not anticipated. Many part time workers are actually having hours cut so the employer can avoid the benefits. I'm of the mind that problems can usually be solved with more freedom and less laws than can be with the opposite.

Inherently, because women are at more risk for more health issues, they will end up spending more, just by virtue of how they were born.

Are you sure to say that so confidently? I believe that is a misconception on your part and goes against a lot of what I've read on the subject. But if you have a source to back that claim up I would be quite interested.

Would it be fair to, say, impose a tax on all baby boys when they're born just because most people in the prison system (using your tax dollars) are male?

I am against taxes... but health insurance is not a tax :)

I'd also argue (just to play ball, since I think the above argument is my main one) that 1: Women get much shorter sentences than men, which makes up a large part of that disparity and 2: Men are already paying a lot more in taxes than women so it would probably already be included in that tax bill.

I would again argue that the current system also "limits freedoms". Many people are currently priced out of having any healthcare plan at all.

They have the freedom to work more or harder. If they're a truly disabled person or a mentally handicapped person then I agree that those people should get different considerations... but we aren't talking about those people. Ultimately what you're doing it forcing someone who worked hard (which is what a modern doctor is) to give treatment to someone that decided not to. Maybe you shuffle the money around and make all professionals bear that cost instead of just the doctor but in the end that is what is really going on.

He actually does address the issue of restricted freedoms, namely the mandate, which forces people without insurance to pay a tax (since the court ruling makine it a tax as opposed to a fee). He explains that the mandate is necessary because it strikes a very realistic bargain with the insurance companies by making it so that everyone has to pay into the system preventing people form just signing up when they need it.

Next you voice concern over the ACA not providing any means to reducing health care costs overall, which is also isn't completely accurate. A large portion of the reason for this bill existing is to reduce health care costs by reducing spending on treatment of acute illness and shifting it to preventative care. Erly identification of illness reduces the burden farther down the road. The ACA also reduces costs on the whole by attempting to provide healthcare for the poor because they more often than not do not have primary care or preventative care meaning they recieve care in dire circumstances (they experience acute chest pain, go to the emergency room at a public hospital without insurance and the bill gets footed by the state) increasing costs on the public.

I'm not sure what else you want the Act to do to reduce health care costs, wht actions would propose be taken to reduce costs that would be less intrusive than the mandate that everyone have health care or pay a tax?

You state that the Act requires men to pay for the costs of women's health insurance despite the "fact" that women spend more on health insurance. That is a pretty bold (and somewhat misogynistic) statement and I would love to see some sort of document supporting it, extraordinary claims require at lest ordinary evidence. You also seem to equate people without children to men and people being for forced to pay for other people's kids with paying for single mothers kids, you don't say it outright but that seems to be the underlying message. Even if you did not mean that, parents still ahve to pay for their children's healthcare until those children turn 26, its not just free for them so the only people paying for it are the children's parents.

Your last sentence makes almost no sense, are you saying that insted addressing the (made up) concerns of many conservatives he should have explained how the ACA doesnt take away your freedom? I would also like to know which freedoms I no longer enjoy due to the ACA.

You state that the Act requires men to pay for the costs of women's health insurance despite the "fact" that women spend more on health insurance. That is a pretty bold (and somewhat misogynistic) statement and I would love to see some sort of document supporting it, extraordinary claims require at lest ordinary evidence.

there are a couple health costs unique to women, like seeing an ob/gyn for example, or pregnancy stuff.

The most succinct explanation I can give for the ban on gender discrimination is: Being female is a pre-existing condition. Insurance companies are no longer allowed to charge more because of pre-existing conditions, ergo it's illegal now to discriminate cost based on gender.

That's exactly the point. There is nothing about being a woman that makes one inherently more at risk for health conditions, in fact the opposite is true. But women have two things that cause them to spend more money on healthcare (on average) then men. First is pregnancy, the other is the fact that they live longer.

The pregnancy issue is a horrible reason to charge more to specifically women. For the most part, pregnancies are a choice between a man and a woman, not a sickness. Should women bear the burden of paying more throughout their lives just because she is capable of being the sole party in a relationship that can bear children? That is simply not fair.

(why) Should women bear the burden of paying more throughout their lives just because she is capable of being the sole party in a relationship that can bear children?

Because she is also the sole party in a relationship that makes the choice to go through with a pregnancy.

Being a women is a pre-existing condition, (just like being a man is) but in modern day society it is almost exclusively a choice that women make to go through with pregnancy.

If a women decides to go through with a pregnancy she should bear the financial burden of going through that pregnancy.

Not through higher insurance fees, mind. I dont even think insurance should cover pregnancy related stuff tbh, because its something that people chose to go through, which i think defeats the whole purpose of insurance to begin with.

A woman has an ultimate say about wether or not she wants to keep a pregnancy, but why should she pay more her whole life just because she and her husband mutually want to have a child?

Pregnancies are (typically) mutual endeavors. Charging one party more is unfair.

Also, people couldn't afford pregnancies without insurance. They can cost up to $15,000 just for the birthing, plus all the expenses beforehand, plus all the costs of buying baby stuff, plus all the upcoming costs of raising a child. People in this age range are often still paying off debt from student loans. Add another 15K in there on top of raising a child, no way they will be able to save for their future (or their child's education). At the end of the day, pregnancy is a special category of "elections" because without it, society would stop. Also, it's a pretty base human drive.

A woman has an ultimate say about wether or not she wants to keep a pregnancy, but why should she pay more her whole life just because she and her husband mutually want to have a child?

And I agree, she should not have to pay more insurance. I dont think pregnancy should even be covered under insurance.

Also, people couldn't afford pregnancies without insurance. They can cost up to $15,000 just for the birthing, plus all the expenses beforehand, plus all the costs of buying baby stuff, plus all the upcoming costs of raising a child.

Does not change the simple fact that having a baby is not (i dont think) covered under the idea of "Health insurince". Health insurance should not cover procedures you voluntary undergo for reasons outside your health. It should not cover plastic surgery or hair replacement, or other procedures that are not crucial to your health and well being.

I think a better solution is to have the government subsidize the whole raising children procedure, from contraception to university. Its in societies (and thus, the governments) best interest to ensure that future generations are birthed and raised properly, so I think the government should play a larger part in that whole process.

I was defending the current model against the view that people should fend for themselves on the whole child raising process. If you look at some of my other posts, I totally support federal involvement. Nice way of thinking about it though!

Doesn't this assume that all women have access to contraceptives and abortions? Depending on where you live, your income level and age you may not have means to, or, it may be extremely difficult to terminate your pregnancy.

It does, yes. But I dont think the percentage of people who dont have access to contraceptives and abortions in the united states are statistically significant. Feel free to provide some citations showing otherwise though.

The number of U.S. abortion providers remained stable between 2005 (1,787) and 2008 (1,793). Eighty-seven percent of all U.S. counties lacked an abortion provider in 2008; 35% of women live in those counties.

there is a subreddit where you can submit studies behind pay walls and people will fetch them for you... cant recall where.

Anyways, I would say that you dont need to buy a morning after pill and other such contraceptions at an abortion provider, and that the majority of those people could simply travel to a county nearby that had an abortion provider.

I see couples make the decision to have a baby all the time. Sure, a woman cannot be coerced into having a baby against her will, but certainly you agree that 2 people are making the decision together in some cases, in the sense that the woman might make a different decision without the other parties' input and pledge of equal responsibility.

You position appears to be that women take on the medical cost of perpetuating the human race. Surely you are not saying that.

the decision to try and have a baby is a mutual one (sex requires two participants after all) but the the decision to remain pregnant and cary the baby to term (the only decision that really matters) is all on the mother.

My position is that the medical bill for a procedure that the patient does not need to maintain health and welbeing should default to the individual who chose to undergo said procedure.

Of course, having children is special. Which is why I also think the government should heavily subsidize the entire child raising procedure. From contraception to university, the whole process should be as cheap and streamlined as possible.

Its in everyone's best interest that future generations come out healthy smart and productive after all.

But I do not think pregnancy falls under the purview of "health insurince".

I guess my question is why do I care if women "spend" more on healthcare? Individually, you're still free to get all your maladies taken care of and so are they. Further, a healthy society benefits all participants, so just because I am paying a little more for healthcare than I consume on average, I still benefit from healthy friends, family, co-workers, acquaintances, strangers, etc.

I think its silly to make much of a fuss about who spends what on healthcare, we are all in this together, so to speak.

But we aren't.

In literally every single public program, by which I mean those policies the government enacts to provide goods and services that are also provided by markets (so not Defense, not disaster relief, not police, not firefighters), the consumption of those offered goods and services is always skewed.

When consumption of government services is unequal (and this is particularly true for healthcare) and the taxation to fund those services is unequal (which I don't think I need to explain), it's pretty clear that Peter is paying for Paul.

. You say the consumption of the goods is skewed, but I dont understand what you mean by that

I mean that people don't use healthcare uniformly in this country already, even when they have access to covered services because they've purchased insurance.

Cost of insurance

Number of services covered

Portion of expense expected to come from out of pocket

Degree of healthcare use

All of these are unequal even after we split the country between taxpayers and non-taxpayers, and after we further split between insured and uninsured.

If Bob generates 500 dollars per year in healthcare costs, and pays only 250 dollars in taxes each year, and Jim generates 500 dollars in healthcare but pays 500 dollars in taxes to healthcare Jim is effectively subsidizing Bob.

The numbers are far more unequal in many more levels of stratification.

The link you provide is to PJM, that's hardly a credible source of any kind of information. On top of that the article, if you can call it that, simply asks if there is more information health care spending on a gender basis. Had you looked at the NIH report cited more closely you would have seen that 60% of costs occur after the age of 65, considering that women on average live longer than men this is not surprising. So if women live longer than men and continue to recieve insurance coverage past the age of 73 (or whatever age men live to on average) is lving past that age forcing men to pay for women's health care costs?

I linked to it because it provided a more susinct summation of this study then I wanted to bother writing, and its where I found the study in question.

And aye I saw that, but of course it makes sense that if you live longer you pay more insurance.

But the fact still remains that women on average spend more on healthcare, which is why I showed you the study in question, as you yourself requested a bloody citation.

So if women live longer than men and continue to recieve insurance coverage past the age of 73 (or whatever age men live to on average) is lving past that age forcing men to pay for women's health care costs?

No its forcing everyone to pay for for everyone else's healthcare costs, which makes sense to me.

And I already have, and they make the case that being a women is a pre-existing condition (which also makes sense) but they also claim that women should not have to pay more insurance because there are at risk of pregnancy, and I disagree.

I dont think women should have to pay more insurance for pregnancy because I dont think insurance should cover pregnancy. I think pregnancy should be irrelevant to the whole equation, as it is a choice that women make to go through with the pregnancy itself.

wht actions would propose be taken to reduce costs that would be less intrusive than the mandate that everyone have health care or pay a tax?

Allowing medical practitioners to compete without the AMA approval is a clear way. For example, a person could learn to use an MRI machine, buy one and set up an office and do that one task fantastically with enough practice.

Another clear one would be to stop medicare paying for a truly massive amount of healthcare at the very end of a person's life. That is politically unpopular but it is a serious free rider problem. Given the choice I imagine most old people would rather let their family inherit an extra hundred thousand dollars than go through an expensive procedure that will extend their life one month (which would be spent in the hospital).

That is a pretty bold (and somewhat misogynistic) statement and I would love to see some sort of document supporting it, extraordinary claims require at lest ordinary evidence.

This isn't an extraordinary claim at all. It is actually common knowledge that women's health insurance costs more than men does. And if you took the time to read the guy's post (and it is obvious you didn't based on your comment) then it was stated right there that part of Obamacare is that insurance premiums must no longer charge women more than men. I mean how much more clear can you get. I guess plain facts that work against your world view make someone a misogynist though?

You also seem to equate people without children to men

Now you're just trying to twist what I wrote into something that I didn't at all. I stated very clearly "people without children".

Anyway that is where I will stop reading. You're not one I would like to carry on a conversation with - from all of your delusional personal attacks. Good day.

Another issue he didn't even bother to mention at all is that Obamacare does (almost) nothing to reduce the cost of healthcare. Somehow the USA spends more than any other country by far, as a percent of GDP, on its healthcare. And this bill doesn't make healthcare more affordable for middle class families in any way. If you read through that list I can't find a single thing that will actually reduce the cost of healthcare overall. So if it isn't reducing the cost then how exactly is it more affordable?

I mean you could still be paying for healthcare without insurance I suppose. It's the insurance thing right? Or does health care still cost more with insurance?

And this bill doesn't make healthcare more affordable for middle class families in any way.

Yes it does. Premiums will be capped based on income and family size. Middle class families will pay according to how much they make.

As far as controlling long-term costs, the main push is in reducing long-term preventable illnesses. This is why all insurance policies will now include check-ups and many screening procedures for free. Many people forego necessary health care because they can't afford it right now, or don't feel that they will benefit from the upfront cost. Making preventative care available for no additional charge changes the incentive structure to make people more likely to use these services.

It additionally reduces the cost to the government by changing how Medicare/Medicaid reimburse for certain procedures.

Oh I understand where our disagreement comes from now. I was not classifying people under that portion of Obamacare as middle class. I guess there isn't some general consensus on what middle class is, though. To me it meant households with about $100,000 in income. These people did not receive a benefit from Obamacare. And if they do now they likely won't as incomes begin to rise.

Many of them will. My parents make a little over $100,000, but both of them are self-employed. Are you familiar with the incredible price gouging insurance companies do to self-employed people? People like my parents will be able to save substantial amounts of money in the group insurance exchange markets.

They won't receive tax benefits, they will simply have access to substantially cheaper policies. Currently the individual insurance market is way more expensive than group insurance policies. Here's a basic article about different types of insurance.

Note:

Individual health insurance is the most expensive option for people who don't have coverage (or don't have enough coverage) through employers.

Starting next year, everybody will have access to group insurance policies through the state-based exchange markets.

I think you have to consider that providing health care to the poor can help reduce long term costs that all tax payers have to bear. I.e. If a poor person goes on disability and can't work because they can't afford to pay for a simple surgery, it puts far more long term strain on the tax payers. It may not seem 'fair' on the surface but providing healthcare (and other social services) to the poor is a means of reducing the costs of long-term poverty.

I think he was just responding to the most common (and loudest) criticisms of Obamacare.

I heard many of my own friends mentioning Death Panels and the Pelosi quote. I think the major assumption of your argument is here:

real concerns which are plainly unfair to some people, and limit the freedom of all people.

I don't think most people agree with your assessment, and I don't think it holds up to logical scrutiny.

What you call unfair and freedom limiting can be applied to any tax or any government service. If I live in a home built to current fire codes, why should I pay as much taxes to fire departments as people who have 100 year old homes? Why is it ok that my freedom is being limited in this manner?

What you're talking about are mostly issues of local taxes. I am not so vehemently against these because people actually have some control over them and the laws are actually flex with the desires of the people much better.

Another thing is that fire departments, police forces and many other services are still beneficial for all/most individual parties, even if things aren't completely fair. This is because the cost of having a fire station for an area is going to be very similar regardless of how many houses there are. Having your own private fire station wouldn't work. And the increased cost of constantly monitoring everyone's house would add a lot to the bottom line cost as well. It is simply cheaper to ignore that.

Another problem with your argument is that two wrongs don't make a right. You're right, we've given up some of our freedoms. The conclusion from that for me isn't, "So who cares about the rest of them?" It is, "I really want to fight for the freedoms I have left."

Well, if my house is made of stone it's not going to burn down in less than two hours. So I can have a fire station an hour away. Your house is made of wood, it can burn down in 20 minutes, you need a fire station 10 minutes away. Why am I paying for your firestation?

Why am I paying for a Coast Guard if I don't live near an ocean? Why am I paying for an immigration department if I don't live near a border? Why am I paying for the FAA if I don't fly? Because my life is improved by the fact that all of these institutions exist. Am I getting less use out of these institutions than some others? Yes. Does that mean that I am paying more per use than some others? Yes. But here's the important part: is there a more affordable way for these institutions to run? Probably not.

I agree with your theory that Fire Stations benefit all of society. I happen to think that keeping people (especially poorer children for example) healthier also benefits all of society. They'll live longer, be more productive, be less of a burden, and be better to be around in general.

I also think that Obamacare has been shown to reduce overall expenses for healthcare. There's a GAO study and other studies to that effect. Do you challenge this?

I think you're making assumptions about my argument. I don't think we've given up any of our freedoms by having fire departments. I think we have more freedoms because of fire departments.

I think the long term effect of paying for roads and policemen and internets is that we as individuals have more capital, more spending power, more access to more choices.

I'm a practical libertarian. You should like a more philosophically pure libertarian (though I apologize if my assumption is inaccurate.)

I bet we would love to go build a cabin on a mountain, shoot our own food, and live off the grid together for a while. I also bet that I would not want to live in what would result in your "utopia", and that you would complain a lot but would be otherwise quite happy in my "utopia".

I'd rather fight for the freedoms that have been taken away, but I hear what you're saying otherwise.

If nothing else, it's nice to hear a dissenting opinion. I hope you keep this throwaway running.

Why am I paying for a Coast Guard if I don't live near an ocean? Why am I paying for an immigration department if I don't live near a border? Why am I paying for the FAA if I don't fly? Because my life is improved by the fact that all of these institutions exist. Am I getting less use out of these institutions than some others?

Well for all of these there is a strong national defense component that all of us do benefit from roughly equally. That alone justifies the existence of them and even hardcore libertarians value national defense. Definitely some people don't want those things but they are an exceptionally small minority.

I happen to think that keeping people (especially poorer children for example) healthier also benefits all of society.

I doubt you'd be hearing nearly as many murmurs about lack of freedom if all we did was provide completely free healthcare to people under 18 or 21 or whatever. I mean I definitely am not in favor of that but it is overall a much smaller concern to me than the idea that capable adults should not be paying for their own necessities in life. I am a pretty big libertarian but if that is all that was done I wouldn't be outspoken against it at all - just privately against it but would shrug it off.

I also think that Obamacare has been shown to reduce overall expenses for healthcare. There's a GAO study and other studies to that effect. Do you challenge this?

Yeah I frankly don't believe that Obamacare will reduce the health care costs much (if any) at all. It might reduce it a tiny amount but not a real effect that you could really say is solving the big problem. Do you actually believe that some new incentives to do preventative care will actually fix health care costs?

Well for all of these there is a strong national defense component that all of us do benefit from roughly equally. That alone justifies the existence of them and even hardcore libertarians value national defense.

I don't think I've directly benefited at all from the wars in the middle east at all. Or, to put it another way, people living in the center of the country don't directly benefit from security at the borders.

The FAA regulates commercial airline traffic. If I don't fly, why should I pay for that service?

With regards to adults paying for their own necessities, how do you feel about mandated vehicle insurance? Do you see any similarities between that and mandated health insurance?

I thought the cost reduction was supposed to mostly be from A)getting healthy people into the system and thus making the average price per user less and B) allowing people to go to the hospital when sick (not strictly "preventative" but not strictly "emergency") so they could be treated before their condition became catastrophic.

I used to work with a guy who couldn't get health insurance because of existing conditions (one of which was diabetes). So, once a month he would run out of insulin. Then he'd make his way to the local emergency room where they'd treat him. They of course recognized him, and would give him as much free insulin as they could get away with. That would last him about a month.

He was a Journeyman carpenter, but after he got cancer he couldn't work enough hours to keep his union membership in good standing. A few years later was when I met him. No health insurance, could really only work 60% time.

If he had the ability to just get insulin, it would have resulted in one less emergency visit a month. I won't go into too many details of his sob story. Suffice it to say that he worked hard, wasn't looking for handouts, but didn't want to die.

I hope he's an outlier, but I'm sure there are less dramatic yet similar examples of how having access to medical treatments can reduce the overall cost of medical care.

The FAA regulates commercial airline traffic. If I don't fly, why should I pay for that service?

Well for roads, for example, we tax gas so that it is people that drive and buy goods that need transporting that end up paying for them. I wouldn't be surprised if that already exists for commercial airline traffic. I do know that every time I fly I pay some portion of airport taxes/fees. If that completely covers the FAA I don't know. But I agree that if it doesn't then they should use that type of tax to pay for this service.

There is definitely some component of the FAA that is national defense oriented. Without it we couldn't properly defend our airspace. To me that justifies that some portion of the operation be completely public.

I don't think I've directly benefited at all from the wars in the middle east at all.

I definitely agree with that and think we never should have started these wars (I said this as a teenager when the vast majority of Americans did seem to support those initial bombings we did). I don't think that has anything at all to do with national defense and I am disgusted by our actions. I don't think anyone should have to pay for that. That said, this is clearly a lot different than actual national defense which is what I was trying to talk about.

people living in the center of the country don't directly benefit from security at the borders.

I just don't agree with that. Let's say another 100 million people flooded into the USA because of open borders. They would quickly become a burden on our various social safety net programs for everyone all across the USA. It is also questionable if they would choose to stay in the border states for long, especially since work in those areas would dry up quickly. I think with the types of welfare programs we have in place right now it is important to disallow completely open immigration. But if we didn't have such programs then I strongly favor open borders actually because I don't see how an American's life is more valuable than any other.

how do you feel about mandated vehicle insurance?

This is a state issue and because of that I feel a lot better about it. Some states don't actually require it. The nice thing is that individuals can much better tailor what they want by moving to the state they find is the best fit. That has constantly been deteriorating over time. For example, the reason all states have a drinking age of 21 is that the federal government effectively took that option away from the states in the form of a heavy tax penalty.

If the majority of voters in the state I lived in voted for universal healthcare, within that state, I wouldn't have nearly as much of an issue with it.

As for your friend's story: Why couldn't he just buy the insulin he needed? I just looked up the prices for that drug and it really isn't that expensive. Maybe it was a long time ago when the price was very high, though?

I personally think they will as well. But I don't really want to make that claim when I am not that sure about it. I am kind of astonished that so many guys are saying concretely that somehow we are going to be saving money with Obamacare. Ok yeah, people will get screened slightly more often for various conditions. Will it really have a huge impact? I doubt it. Do Americans get screened way less right now than all of the other countries that are spending a lot less on health care? Not from what I've read.

I have a question! Did the sequester change anything with medical insurance? It seems like my office has to resubmit forms or something and there is this person in my office who keeps pinning it on Obama and Obamacare. I was just wondering if it is Obamacare, or it could be something else.

Note: I am reading through that long post so idk if the answer is in there -l-

The sequester only affects discretionary public funding. Medical insurance is a completely private industry. The reduction in public funds and the need for your office to resubmit forms to your private insurance company are totally unrelated.

It sounds like a mistake was made somewhere along the line, and somebody is just frustrated and wants to blame Obama. But no, sequester isn't the cause of you guys needing to resubmit forms.

There is no inherent "better" or "worse". If you were to ask my personal opinion, which is completely irrelevant to this discussion, I would say that a Single Payer system is the most effective and efficient means of providing quality healthcare for our nation. But that is a totally moot point.

I believe there were three options available to us when we decided to do an overhaul of the healthcare system in America:

Implement a Single Payer system, where the government is the main insurer. Taxes would go up, and everybody would be given insurance through the government. Like in Great Britain, there would still be a market for additional insurance for those wealthy enough, but everybody would have insurance through the government.

Public Option. This would allow the government to sell insurance to anybody that wanted it. It would essentially be an expansion of medicare, and if you wanted to buy your insurance through the government, you would be able to.

Overhaul the private sector, keep government out of healthcare.

For many political reasons, #1 and #2 were impossible to pass. If you think people are angry and upset at what Obamacare is, I shudder to think about what the reaction would have been if government was suddenly able to sell and provide insurance directly to anybody. There is a strong belief in our country that the Private Sector is always more efficient than the government, and that expansion of government is an inherent reduction of liberty and freedom. "I don't want to pay for healthcare at all, so I would be upset if my taxes got raised to give me something I don't want. If I do decide to get healthcare, I want to be able to choose. Anything different is trampling on my liberty".

The belief that the private sector is always the best approach, in my view, should not be taken as dogma. Private industry has a great and important role in our country, and should never be dismissed. However, sometimes things work better when there is a single entity that controls the process. This is just my view, and many will disagree. Both sides of the issue have valid points and concerns.

I don't think we would have knocked down an entire industry overnight. The rest of the Western world has managed to implement various forms of Universal Coverage, and we could have leveraged many of their experiances in the process. I do think we would have needed to take smaller steps.

However, I have hopes that the current system actually encourages a move towards at least a Public Option, if not a full blown Single Payer!

In 2017 states will be allowed to replace the ACA with their own systems, so long as conditions such as coverage and care are not reduced from the current system. Some states (Vermont) will attempt to move to a Single Payer. Other states, I'm sure (but still conjecture), will make a state based Public Option available. If the public option/single payer gains enough traction in enough of the states, it would be a smaller step to "consolidate" the different systems into a National one than it would be to roll out such programs from scratch.

The benefits of privatization are normally the possibility for innovation and efficiency. People are generally wary (and frequently for good reason) about the Government taking things over because it can often lead to narrower decision making or a tedious amount of red tape.

Government can also build interstate highways, provide power and mail to remote areas, create an internet, and put men on the moon, among other things--stuff the private sector is not particularly inclined to do.

Government itself is neutral; it's what we do with it that helps or hinders us.

It's a poor compromise between the "socialist" idea of universal, single-payer healthcare coverage, and unfettered free market capitalism. I say it is a poor compromise because it takes some of the worst parts of both systems and glues them to each other.

Individual mandate: Everyone is required, by law, to have health insurance or face a penalty tax each year. Most employers are required to provide group insurance policies to full time employees, but there is no guarantee of full time employment or any mandate that requires full time employment be provided to anyone. Part-time employees are mostly left out.

Insurance industry "reforms": Among some of the reforms in the bill are measures meant to help control the costs of insurance, but they are toothless for the most part. The biggest one is the 80% mandate which requires insurance companies to use at least 80% of their premiums revenue for healthcare, not overhead or profits. The problem is that some of the biggest providers have been given temporary or open-ended waivers to avoid this mandate. Additionally, this does nothing to stem the rising costs of medical care, or the associated rising premiums. Indeed, the only way to make more profits now is to raise both payout amounts and premiums together.

Healthcare Policy Exchanges: If your state actually implements it, great! Many are delaying and refusing to do it. Even then, I only helps those who are going to buy private insurance policies, not those who go through a group policy at work. It will probably help some people, but it's overly ambitious.

Other reforms: One big reform has been the elimination of denying coverage for pre-existing conditions. Some of the abuses by insurers over the years relied on this clause, so good move. Insurers are making up for this by raising premiums more than they already were. There have been some changes to payment caps and such, but they're not things most people ever dealt with anyway. Deductibles, premiums and yearly maximums still exist, and if something really bad happens, you'll still run the risk of going broke.

I'm all for having everyone in the country covered for medical needs in some way. I'm all for reforming insurance laws as well. What we got with this bill, however, was a giant shift that really took us nowhere. Insurers and providers are still making money by overcharging people. Plenty of people will still be too poor to afford the deductibles and co-pays in addition to the premiums if they don't qualify for Medicare/Medicaid. Which means just as many people (maybe more now) will avoid needed medical treatments because of the associated costs. And again, insurers will be raking in money from all this the entire time, and we will continue to pay much more as a nation for much less health care.

Yeah it is pretty well a hot mess. Politically it is going to hurt the left when it falls flat on its face. If you're going to reform actually do it. This is not it and its going to clobber state governments and the number of hours a lot of companies will let you work. It goes from them fighting to prevent you from working overtime to fighting to prevent you from getting 30 hours.

Emergency care is a small portion of overall medical costs. Most costs come from end of life care and preventative care. For emergencies, you can have catastrophic insurance akin to home or flood insurance. For the rest (the huge bulk of services), there is no reason that the market cannot provide choices based on price and quality.

I'm not convinced this is true across the board, but even so, when you need emergency care, you are not an informed, deliberative consumer.

That is what insurance is actually for. You purchase insurance for catastrophic situations that you cannot plan for. If/when an emergency does occur, it is covered by insurance so that you don't have to make a decision - you already made it.

it is covered by insurance so that you don't have to make a decision - you already made it.

Paying for insurance is not the same thing as receiving care. The quality of your care varies from doctor to doctor, hospital to hospital. In network, out of network costs. In country, out of country costs. Oh yeah, and your insurance may deny your claim or not cover after the fact. How is a consumer going to factor any and all of that into their decisions? The reality is they can't because it isn't a free market.

Paying for insurance is not the same thing as receiving care. The quality of your care varies from doctor to doctor, hospital to hospital. In network, out of network costs. In country, out of country costs. Oh yeah, and your insurance may deny your claim or not cover after the fact. How is a consumer going to factor any and all of that into their decisions? The reality is they can't because it isn't a free market.

It is no different than any other form of insurance. Certain things are covered, other things aren't depending on the type of plan. Insurance markets function perfectly well in other industries. Health care is an exception not because it somehow overcomes the law of economics, but because the health care insurance market isn't insurance, it is an inefficient pre-payment system.

Your "concerns" are irrelevant because they addressed something different than your original contention. Furthermore, all you described was an issue of asymmetric information, which is present in all markets and the very reason markets exist in the first place.

Differences in quality and care is why prices exist. Prices signal to the market the level of quality and availability of supply. You question how a consumer is able to factor all of the information into a decision. This is a silly question since (1) those factors are somewhat encapsulated in the price; (2) consumers make complex economic decisions on a daily basis. People buy cars, people buy homes, people purchase investments and make many other large economic decisions. The complexity of the decision should not be a reason to shun market principles - it is the very reason to embrace it.

You are describing the industry as it is - due to the inefficient laws and regulations that shape the market. You are not describing how the market would work if non-emergency care was purchased and negotiated like virtually all other goods and services and emergency care was covered by insurance - which is how every other insurance industry works.

I guess my problem with that distinction is that there are non-emergency procedures that are not foreseeable. I suspect you mean that insurance should cover things that are catastrophic, but there isn't a black-and-white definition of catastrophe.

If you are looking for a meta distinction between emergency and non-emergency procedures, you will not find one. But how is that different than literally everything else? What is and is not covered as emergency care will be negotiated by patients and insurance companies.

My question is -- at what point should my mom have to pay for this whole chain of events?

You're asking me a logistical question I do not have expertise on. It is like asking me: How does the local supermarket sell Kiwis from New Zealand? The answer probably involves millions of smaller transactions across industries by thousands of economic actors. But just because I can't describe in detail the logistical components that make it possible, that doesn't mean actors within the industry couldn't figure out a more efficient system. I can still go and grab some Kiwis.

Mandate: Any employee not offered reasonable policy through their employer is eligible to take part in the exchanges. In addition, premiums will be subsidized for those making up to 400% of the federal poverty level. So it's not really fair to say these people are "mostly left out."

Reforms: The waivers to avoid the 80-20 coverage rate are meant to be temporary. It's too early (IMO) to declare that a flaw. And in the meantime, there are plenty of other substantial reforms in the law (e.g., can't deny for preexisting condition, children can stay on their parents' policy till 26, etc.--which you do mention later).

Exchanges: If states won't do it, the federal government will. There will be exchanges in every state--it may be delayed because of the volume the federal government will have to implement. States not implementing the exchanges themselves are handing that power over to the federal goverment--an interesting action for those politicians who usually espouse "states rights."

The next few years will be interesting. There's a lot of good in Obamacare, and there are a lot of holes in it, too. Personally, I wish people would put their energies into improving it rather than destroying it altogether. It's demonstrably better than what was in place before.

The benefits of Obamacare are well noted, and include patient protections that were not in place before, such as: (1) no more denial because of preexisting conditions; (2) curbs on canceling insurance policies; (3) no more annual or lifetime limits. In addition, there is substantial financial aid for the poor and lower middle class, including subsidies and the disappearing “donut hole” in Medicare part D. Also, new insurance plans have to be rigorous; no more of the truly crap policies that covered next to nothing and were basically scams.

Here are a couple things that have changed in the past few years that some are attributing to Obamacare:

I'm not really sure what you're questioning, though, to be honest. Do you agree that these things are improvements? Or, maybe, do you think the negatives outweigh the positives? Do you think things were better before Obamacare? If so, can you provide evidence?

Well, this is to be expected. The question is does it matter if you're "insured" but can't even afford your deductible anyway?

The point I'm getting at is unless it's more affordable, what good is being "insured"? My last job had insurance, but it was ridiculously horrible. It essentially prevented the employees from qualifying for State programs, but that's it. Yet they counted as "insured" persons.

The insane growth of medical costs is slowing:

The article doesn't attribute this to Obamacare:

" The reason for the turnaround will require additional reporting."

You're stating it is demonstrably better, but there's no demonstration that it is. The reason costs have slowed(they're still increasing, just at a lesser rate) isn't shown to be Obamacare(it's not even fully implemented).

That's nothing to gloat about, obviously, but if you compare that to what an uninsured person could be held responsible for prior to Obamacare, that is a demonstrable improvement.

Those totally crappy plans (which is what it sounds like you had through your last job) will no longer be available. And they were scams--absolutely.

Compared to what was in place before Obamacare--all those things I listed in my past couple posts are improvements--you haven't denied that, right? You're just denying that I can demonstrate them? They are the law--or will be next year. Other than point you to the text of the actual law, I'm not sure how to "demonstrate" them.

"Compared to what was in place before" --that's the kicker. Our health care system before Obamacare was insane, stupid, and deadly for too many people. Obamacare didn't wave a magic wand and make things better, but it's a start.

(Heh, I did waffle on that last claim--that's why I used the qualifier "some are attributing" them to Obamacare. The future will tell, I guess, but it's a good trend and I surely hope it continues.)

no more denial because of preexisting conditions
curbs on canceling insurance policies
no more annual or lifetime limits

These are improvements. However, it remains to be see how these changes will affect prices. If they can no longer limit payouts over the lifetime of the insurance, will they jack up rates?

Just because 80% must be spent on care and not administrative costs/profit doesn't mean they can't raise rates.

"Compared to what was in place before" --that's the kicker. Our health care system before Obamacare was insane, stupid, and deadly for too many people. Obamacare didn't wave a magic wand and make things better, but it's a start.

This I guess is what I'm getting at. It really doesn't do much. In fact, I'm actually seeing people who are normally opposed to any Government involvement at all in the healthcare system advocating Single Payer over this.

Frankly, we haven't seen how the insurance/healthcare fields are going to react to these changes to make them claim it's better, or worse, than before.

I agree that the 80-20 rule won't by itself lower prices. Keep in mind, though, that insurance companies will also have to have large increases in premiums (>10%) approved--so they won't willy-nilly be able to raise premiums by 25% just because they want to pay the CEO more.

Interestingly, I'm also seeing people normally opposed to government involvement now advocating for single-payer. While I cynically wonder how much of that is sour grapes (after all, Obamacare is Obama's big accomplishment), I don't really care. At least those people are admitting they don't want to go back to the mess we had before, and that feels like moving forward.

The lack of a Medicare buy-in would have been government-run insurance versus private insurance. It would have changed the entire landscape of the health care situation. Because it's not there, private insurance keeps going on with business as usual, costs keep going up, people keep spending more to get less, which prices many people out of actually using the health care coverage they're paying for.

I'm thinking we might have to agree to disagree on the results, but the inclusion or exclusion of a Medicare option is not a minor point.

Agreed, the lack of a Public Option is disappointing. But given the current political climate around what Obamacare is, can you imagine what it would have taken to get a Public Option passed?

In the end I think we got the most we could at that point in time. We should be happy and proud. What we have will keep us going for some time, and in a few years we can try again.

Also, in 2017 states will be given permission to replace Obamacare with some other system, so long as it performs as efficiently as the PPACA. Vermont has already indicated that it will pitch a single payer system. Other states may begin to offer public options on a state level. Obamacare set the bar, then challenged states to do better.

I'm not as optimistic about it. We tried to have universal coverage in the early 1990's, and what we now call Obamacare was proposed as the conservative alternative. Now we have that enacted without any of the consumer protections needed to make it actually work for most of us, and in 4 years the states get to replace it with, well, whatever they want to, really. It will end up making the ACA repeal votes and states AG legal challenges look like pre-fight smack talk.

I actually have better hopes than that, and they all revolve around what happens after 2017!!

In 2017 states will be allowed to apply for waivers allowing them to opt out of many large parts of the PPACA, so long as certain criteria are maintained.

Basically: If a state believes they can develop a system to deliver a similar level of coverage and care as the ACA, they can pitch their plan to the Federal Government and replace the ACA in their state with their own plan! The state of Vermont has already expressed interest in moving to a single payer system. Other states may offer a Public Option. We could see many different models pop up over the country, and then hopefully pick one of the better ones (that is politically feasible to pass) and replace Obamacare with yet a better system. Rinse, repeat! Iterative progress.

I'm curious to see what kinds of systems states like Texas and Oklahoma pitch. They have four years to work on a replacement, so even if it's very different it could still be good!

We have lots of them at various levels. Car insurance, home owner's insurance, now health insurance, not to mention car registration/inspection fees. The reality is that everyone in the country really does need some sort of health coverage because of how our health care system works. It's not unreasonable to tax and provide that coverage, but to do so in this way is just another form of corporate welfare.

We have lots of them at various levels. Car insurance, home owner's insurance, now health insurance, not to mention car registration/inspection fees.

These are all false comparisons.

Many people do not choose to drive and pay no car insurance. You are only required to buy car insurance if you drive on public roads. You are not charged a "Mandate Tax" if you choose not to buy car insurance.

Home owner's insurance is not required for those who do not own homes. I'm not sure if there is a penalty on a home owner who has no insurance, so I looked it up;

No. Homeowners insurance is not required by law. However, if you finance your home through a mortgage lender, the lender usually requires homeowners insurance

Again, a false equivalence.

The reality is the "Mandate Tax" created by Obamacare is a brand new invention and power given to the government. One that has never been used before. And now that the supreme court has said the goverment can levy a "Mandate Tax" without violating the constitution; I do wonder what the next one will be.

The reality is that everyone in the country really does need some sort of health coverage because of how our health care system works. It's not unreasonable to tax and provide that coverage

I disagree. I find the "Mandate Tax" completely unreasonable, as well as the precedent it sets for future use.

Obamacare faces new legal challenge: Its 'tax' still violates the Constitution The Supreme Court saved Obamacare by deeming the law's individual mandate a 'tax.' But in that case, the law violates the Constitution's Origination Clause, which says all tax bills must originate in the House, not the Senate. Letting the law stand sets a dangerous precedent.

I'm not a lawyer, but as far as I understand it someone would need to be "taxed" by Obamacare to have "Standing" to sue on these grounds... so I'm not sure if this particular case will get any traction. But I do think this is an interesting point and I have not seen it refuted beyond out of hand dismissals. I'd love to see anyone show where it did in fact originate in the House.

This has nothing to do with making the "Mandate Tax" illegal, by the way. Now that the Supreme Court decided the "Mandate Tax" was constitutional, the only thing that can get rid of the "Mandate Tax" as a legal concept is by a constitutional amendment. It just may effect Obamacare specifically.

Obama: Mary, show me your piggy bank. Oh, wow, you really are broke. Ok, tell you what. You still have to buy insurance, but I'll help you pay 95% of the cost.

Mary: thank you.

Obama: you're welcome. We just need you to fill out this 60 page form with detailed personal and financial information to determine your eligibility. Then, you will get a credit on your taxes...next year.

I've read that Forbes article too, and it's the reason that I made sure to state that it was still being worked on and improved.

But to be fair and get to the truth, I had already done some additional research into the authors claims. I found that his is not a common view. Other Forbes bloggers do not share this view, and a search of other articles that mention the increased possibility of fraud almost all reference (or link directly to) the Forbes article.

To me this indicates that the "abuse" line all stemmed from one article, and is not widely held. The fact that multiple industry persons did not come to a similar conclusion causes me to largely dismiss the claim as "probably not true".

Mine was a lazy search to be sure. I stand by my assertion that the process is a hot mess. For years I was a manager that employed a lot (read many hundreds if not thousands during my time) of entry level/seasonal employees. Those who are most likely to need subsidies. While anecdotal, I have reviewed a HUGE number of W-4's. As an employer you are not allowed to give advice on what to fill out, but direct them to the instruction pages. Let me just say, this 1 page form is not easily understood by most. Another way to say it would be that it's confusing as fuck all, and few of these folks really know what to put or even give a shit. I also had to deal with the repercussions at tax time.

Bob: You guys messed up my taxes. They say I owe $600.

Me: Bob, you are single with 1 child and put down 9 witholdings, is that correct?

Bob: Man, nobody understands that stuff! You owe me $600.

Rinse. Repeat. So, let's just say I am skeptical, dubious, and downright cynical that this will be an effective process.

I've filled out my share of W-4's as well, and I think the form is straight forward. Anybody that is confused should just ask their HR person.

But regardless, being skeptical is a fair position to take. I'm cautiously optimistic, but that's because I believe that, even if things get off to a rocky start, people will honestly work hard and try to make it better. Nothing is set in stone, and we should all try hard to improve the process rather than just complain about how shitty it is.

Obama: Why didn't I get some legislation that offers some sweet tax intensives to insurance companies that offer a pre-existing conditions plan. That would have offset the insurance companies obvious impending loss on preconditions, rather than developing a law that mandates people to participate in commerce (by forcing everyone to buy insurance) and forcing the insurance companies to cover everyone at any time! That way the precedent of the "Mandate Tax" can't be used in the future to force American Citizens to buy whatever the government feels they need to buy! Aw well. Time for some golf anyway.

By that metric we already have universal health care. John Green actually sums this up pretty well:

We also currently have socialized medicine, we just have an outrageously bloated and inefficient system of socialized medicine because there are hospitals in America where anyone can go and get treatment. That treatment may eventually bankrupt you and it may be of poor quality, but you can get it. And I would argue that it’s the inefficiency of our socialized medicine that in the end makes health care so much more expensive than it is anywhere else in the world.

You get treated in the ER only. If you aren't having an emergency, no treatment, plus they send you a bill afterwards for at least the cost of treatment (often more than the actual cost), something that doesn't happen with universal health care.

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It is distinctly not a universal healthcare bill so much as a universal insurance bill and they are different. A Universal Healthcare bill would amount to everyone splitting the cost of healthcare through taxation - this is not what is happening.

Instead people are going to be encouraged through the threat of a fine to buy health insurance. For people who previously could not afford insurance due to pre-existing conditions, the bill would be very helpful.

That being said, it is worth noting that the point of health insurance originally was not to pay for all of your health bills, which is how people tend to treat it now. Insurance is generally meant to cover you in case of a catastrophe - and you pay more for the security of knowing you are covered. Insurance companies make their profits off the difference between the mean cost incurred and the cost they charge. A typical universal healthcare system would remove this aspect by having the care paid for directly through taxation.

Assuming perfect credit markets and reasonable savings (large and unrealistic assumptions now, but possibly not in the future) The median person would be better off paying their medical bills out of pocket, and aside from the value of the security people gain from owning insurance, most people are worse off for it. Furthermore there are many people, usually younger ones at the lower end of the income spectrum who decide that their health risks are sufficiently low to warrant them not getting insurance for some time - and most are better off for it.

Obligating these people to either pay a fine or buy insurance is likely to make them worse off. There are many of these people, but it is important to note that each of these people will not be made much worse off (the fine isn't terribly large) but there are a lot of them. We may, as a society, decide that we are willing to make a lot of people a little worse off to alleviate a large burden from a small minority - that is not ridiculous and we do it all the time.

Getting rid of pre-existing conditions clauses as well will lead to a small negative impact for a lot of people, and a large positive one for a few. Because companies will not longer be able to discriminate based on such conditions, the average payment will have to increase to cover the very sick leading to generally higher payments for the majority and lower for the sickly minority.

The issue I personally have with the ACA is that I find it to be the worst of both worlds. Because it is not universal care but rather universal coverage - there is a lot of additional cost because we forcing people to buy insurance, which, if people were risk neutral (they aren't) would be strictly inefficient. If, instead, we went entirely private, we could avoid many of the perverse incentives and overhead costs associated with the current system. If we went entirely public we could ensure treatment for everyone at a reasonable price (even if the burden of that price is unequally distributed). Under the ACA (only the parts that refer to the mandate and insurance) we are just going to increase spending on health insurance for the vast majority of people involved and depending on the effect of the current market for lemons faced by the system, may end up decreasing overall efficiency with no real gains in healthcare. That being said, pretty much everyone agrees that this probably isn't going to ruin anyone's life and won't even register for most people so it's not the end of the world like a lot of people claim it is.

Its a push for medical coverage based on third party insurance companies and businesses with a number of employees and hours to qualify for businesses to automatically pay for their employees. It also includes mandates, price fixing, and government health panels for implementation and regulation within the health care field. People are required to purchase health insurance or have businesses buy it for them if the requirements for them to be forced are meet. However, many multinational corporations are exempt from providing Obamacare including Walmart, McDonalds, and even REI where the founder of the company was appointed to a position in the Obama administration. In reality so far insurance premiums have rose and businesses, including small businesses, have restricted employee hours and downsized/freeze hiring due to Obamacare mandates. This is a corporatist health care system because the insurance companies lobbied to have this bill because force of purchase enriches them and does not lower prices due to the lack of free market competition for alternative health choices, doctors, and services.

Obamacare faces new legal challenge: Its 'tax' still violates the Constitution
The Supreme Court saved Obamacare by deeming the law's individual mandate a 'tax.' But in that case, the law violates the Constitution's Origination Clause, which says all tax bills must originate in the House, not the Senate. Letting the law stand sets a dangerous precedent.

I'm not a lawyer, but as far as I understand it someone would need to be "taxed" by Obamacare to have "Standing" to sue on these grounds... so I'm not sure if this particular case will get any traction. But I do think this is an interesting point and I have not seen it refuted beyond out of hand dismissals. I'd love to see anyone show where it did in fact originate in the House.

From looking it over, it seems that the difference is that California already had sky-high rates and that ACA is causing other states rates to rise to California's levels.

The one thing that really gets me about all of this is that even the so called "silver plans" that California is bragging are only expected to cover 70% of your medical expenses, so if you actually end up in the hospital room, you can still expect bills for many thousands of dollars.

Here is a few questions I have. While I am all for the cheap medical care for everyone it seems that in order to get this bill through congress most of its original ideas were stripped from it leaving a mess of a compromise. Things that I was wanting that never happened was to allow insurance companies to compete across state lines, I don't understand this at all. Im a liberal and support this quite a bit. Second people like my farther who worked hard all his life but his insurer dropped him once it was found that his heart was over twice the size of a normal heart. It would end up requiring my farther to have TWO heart transplants. (The first heart to find out was bad). I would have created a public option at least for people who have pre-exsisting conditions. Sure it would have cost a little bit and would need gov subsidizing but I think overall would be a good thing.

This comment shows that at the very least your tl;dr is incorrect and does come across as biased. However, I don't doubt that having to provide insurance will be a financial strain on businesses, and is perhaps a flaw in the law.

This is a biased, and wholly and demonstrably incorrect explanation. This kind of response has no business here.

Just to start, full time or part time employment does not matter to Obamacare. Under the law, full time employment is considered 30 hours a week or more, which still covers most part time employees. But even beyond that, Obamacare does not care about the number of full time employees, but the number of hours total worked.

You're 1/2 right. The hours criteria is what sets the threshold for when a company has to start offering health insurance, and to reach that threshold hiring 1 worker at 40 hours is exactly the same as 2 workers at 20 hours.

However, once they pass that threshold, they need only cover workers who work more than 30 hours per week.

I don't recall the ACA being promoted as solely providing healthcare for everyone, although one thing it was intended to do was help the uninsured. It also does a lot of other things that are important, such as eliminating lifetime caps on insurance use, so you're not screwed if you actually get, y'know, sick; keeping allowing college-age kids to stay on their parents insurance; getting rid of the pre-existing conditions clause that let insurers deny you coverage; transparency in what your insurance actually covers, and requiring 80% of premiums to actually be spent on healthcare instead of "administration fees".

The ACA is like what DADT was for the military: a critical stepping stone. When DADT was passed, it was a huge win for the gay community and supporters. A mere decade later, it's an abomination, and repealing it is a huge win for the gay community and supporters.

The ACA is (hopefully) going to help convince people that having the government mess with their healthcare isn't the worst thing in the world, and isn't going to result in death panels, etc. A decade from now, maybe we'll be seriously looking at single-payer.